Physicians who prescribe erectile
dysfunction drugs for their male patients should be sure to discuss the
importance of safer sex practices, even with older patients: that is an important implication of a report
in the July 6 issue of Annals of Internal
Medicine. The analysis of insurance
records of more than 1.4 million U.S. men over 40 found that those
who used ED drugs were more likely to have sexually transmitted diseases than
were non-users.

"Anyone who does not practice
safer sex, no matter their age, can contract an STD," says Anupam B. Jena,
MD, PhD, of the Massachusetts General Hospital (MGH) Department of Medicine,
the study's lead author. "Even
though STDs are quite rare among older men - on the order of 1 per 1,000
individuals - we found that STD rates in men who used ED drugs were two to three
times higher, both before and after they filled their first prescription."

Jena and his co-authors note that ED drugs
have become popular since sildenafil (Viagra) was first introduced in
1998. As early as 2002 it was estimated
that up to 20 percent of U.S.
men over 40 had tried an ED drug. Studies
have shown both that rates of STDs, including HIV/AIDS, are rising in older
individuals as well as the general public and that people over 50 are much less
likely than those in their 20s to use condoms during sex or be tested for HIV
infection. A survey of primary care
physicians found that they rarely if ever discussed reducing sexual risk
factors with middle aged or older patients.

Small studies of men who have sex
with men had associated the use of ED drugs with higher-risk behaviors and
increased rates of STDs. But no previous
study had examined the relationship between ED drugs and STD risk in a large,
representative sample of privately insured older men. For the current study, the researchers examined
health insurance claims records covering 1997 though 2006 from 44 large U.S.
employers. For male beneficiaries over
40 who used ED drugs, the researchers collected data covering one year before
and one year after the first prescription was filled. Each ED drug user was matched with five
non-users randomly selected from the database, for whom claims data covering
the same two-year periods was collected.

The final study group included
about 40,000 men who used ED drugs and nearly 1.37 million who did not. In both the year before and the year after
the first ED drug prescription, users had significantly higher rates of STDs
than non-users did in matching time periods.
HIV/AIDS was the most frequently reported STD in both groups, followed
by chlamydia. Since the prevalence of
STDs did not markedly change after ED drug therapy began, the authors note that
the difference between groups probably reflects higher-risk sexual practices
among users of the drugs. The data
gathered could not indicate whether ED drug use itself increased STD risk, but
the authors are investigating that question in a further study.

"Health care providers need to
recognize that their older adult patients who are on ED drugs are already at a
higher risk of having or acquiring an STD," says Dana Goldman, PhD,
director of the Schaeffer
Center for Health Policy
and Economics at the University of Southern California (USC), the study's
senior author. "Both the physicians
who prescribe these drugs and the pharmacists who fill those prescriptions
should counsel all patients on the importance of safer sexual
practices."

Co-authors of the Annals of Internal Medicine report are
Amee Kamdar, PhD, University of Chicago; Darius Lakdawalla, PhD, Schaeffer
Center at USC; and Yang Lu, PhD, RAND Corporation. The study was supported by grants from the RAND Roybal Center for Health Policy Simulation, the National
Institutes of Health, the Agency for Healthcare Research and Quality, and the Bing Center
for Health Economics.

Massachusetts General
Hospital, established in 1811, is the
original and largest teaching hospital of Harvard Medical
School. The MGH conducts
the largest hospital-based research program in the United States, with an annual
research budget of more than $600 million and major research centers in AIDS,
cardiovascular research, cancer, computational and integrative biology,
cutaneous biology, human genetics, medical imaging, neurodegenerative
disorders, regenerative medicine, systems biology, transplantation biology and
photomedicine.

The Schaeffer Center at the University of Southern
California is distinguished by a staff
strategically recruited for its research and policy expertise. The center uses
a novel, interdisciplinary approach to advance economic, health services and
policy research and to train a new generation of global health policy leaders. Currently, the center conducts research and
policy analysis to support evidence-based health care reform. Studies underway focus on critical health
policy issues related to health care spending and value, the impacts of public
policy on pharmaceutical innovation, insurance design, the macroeconomic
consequences of US
health care costs and comparative effectiveness and outcomes research.